5(s)-(2&#39;-hydroxyethoxy)-20(s)-camptothecin and its preparation and use for the treatment of cancer

ABSTRACT

A 5(S)-(2′-hydroxyethoxy)-20(S)-camptothecin diasterisomer is described which is a better inhibitor of topoisomerase I than either the diastereoisomeric mixture 5(RS)-(2′-hydroxyethoxy)-20(S)-camptothecin, or the 5(R)-(2′-hydroxyethoxy)-20(S)-camptothecin diastereoisomer. Pharmaceutical compositions of the 5(S)-(2′-hydroxyethoxy)-20(S)-camptothecin diastereoisomer are also described as are methods of using the compound for the inhibition of topoisomerase I and for the treatment of cancer.

CROSS-REFERENCE TO RELATED PATENTS AND PATENT APPLICATIONS

The subject matter of the present invention is related to U.S. Pat. No.6,177,439, issued 23 Jan. 2001, and to copending and commonly owned U.S.Non-provisional patent application having the title: Crystalline Form of5(S)-(2′-hydroxyethoxy)-20(S)-camptothecin, and having an attorneydocket number of 30251/09003, which was filed on the same date as thepresent application, each of which is incorporated herein by referencein its entirety.

The present application is a non-provisional of and claims the benefitof India provisional application No. 897/CHE/2006, filed 24 May 2006,and of U.S. Provisional Application No. 60/887,416, filed 31 Jan. 2007,each of which is relied on herein and incorporated herein by referencein its entirety.

BACKGROUND OF THE INVENTION

(1) Field of the Invention

The present invention relates to the preparation of the5(S)-(2′-hydroxyethoxy)-20(S)-camptothecin diastereoisomer ofcamptothecin and its use for the treatment of cancer.

(2) Description of the Related Art

Camptothecin (CPT) is a pentacyclic plant alkaloid first isolated fromthe Chinese tree Camptotheca acuminate by Wall et al., J. Am. Chem.Soc., 88: 3888 (1966). The structure of camptothecin is shown in formulaI:

Without modification, camptothecin is highly lipophilic and poorly watersoluble. Early clinical trials using sodium camptothecin solubilized bysodium hydroxide in water showed that the compound had antineoplasticactivity, and further research demonstrated that the activity was due tothe action of the compound as an inhibitor of DNA topoisomerase I.However, the therapeutic potential of camptothecin has thus far failedto be fully realized on account of toxicity problems and limited watersolubility.

Attempts to provide improved properties for this compound have includedthe synthesis and testing of numerous analogues of camptothecin. Forexample, U.S. Pat. No. 5,004,758 describes water soluble camptothecinanalogues, U.S. Pat. No. 5,734,056 describes camptothecin analogues.Topotecan, an analogue of camptothecin, is discussed in U.S. Pat. No.5,004,758, and U.S. Patent Publication US 2007/0105885.

Various Carbon-5 substituted analogues of 20(S)-camptothecin aredescribed in U.S. Pat. No. 6,177,439. One such analogue,5(RS)-(2′-hydroxyethoxy)-20(S)-camptothecin has the structure shown informula

The U.S. Pat. No. 6,177,439 discloses processes for the preparation ofthe diastereoisomeric mixture of this analogue—referred to herein as5(RS)-(2′-hydroxyethoxy)-20(S)-camptothecin, or as5-(2′-hydroxyethoxy)-20(S)-camptothecin.

5(RS)-(2′-hydroxyethoxy)-20(S)-camptothecin is a 5-alkoxy substituted20(S)-camptothecin analog having a pentacyclic structure. It has chiralcenters at Carbon-5 and Carbon-20 positions. The Carbon-20 chiral centercorresponds to the natural S-configuration. However, the Carbon-5substitution represents both R and S diastereoisomers in anapproximately equal ratio. The molecular formula of5(RS)-(2′-hydroxyethoxy)-20(S)-camptothecin is C₂₂H₂₀N₂O₆. The compoundhas a molecular weight of 408.41 g/mole and a melting point of 190° C.The diastereoisomeric mixture5(RS)-(2′-hydroxyethoxy)-20(S)-camptothecin, which can also be referredto as 5-(2′-hydroxyethoxy)-20(S)-camptothecin has poor water solubility.

The 5(RS)-(2′-hydroxyethoxy)-20(S)-camptothecin diastereoisomer isdescribed chemically as 5(S)-(2-hydroxyethoxy)-20(S)-camptothecin,whereas the 5(RS)-(2′-hydroxyethoxy)-20(S)-camptothecin diastereoisomeris described chemically as 5(R)-(2-hydroxyethoxy)-20(S)-camptothecin.5(S)-(2-hydroxyethoxy)-20(S)-camptothecin is also chemically describedas4-(S)-Ethyl-4-hydroxy-12(S)-(2-hydroxyethoxy)-1,12-dihydro-4H-2-oxa-6,12a-diazadibenzo[b,h]fluorene-3,13-dione,which has the chemical structure shown in formula III:

5(R)-(2′-hydroxyethoxy)-20(S)-camptothecin has the chemical structureshown in formula IV.

Generally speaking, isomers that are enantiomers have, when present in asymmetric environment, identical chemical and physical properties exceptfor their ability to rotate plane-polarized light by equal amounts butin opposite directions. On the other hand, isomers that arediastereomers (or diastereoisomers) are stereoisomers that are notenantiomers. Diastereomers can, and most often do, have differentphysical properties and different reactivity. In another definitiondiastereomers are pairs of isomers that have opposite configurations atone or more of the chiral centers but are not mirror images of eachother.

Thus, it is clear from the foregoing that it would be desirable toprovide the benefits of camptothecin in the treatment of cancer whilereducing or avoiding one or more of the undesirable side effects ordisadvantages that has heretofore limited its usefulness.

SUMMARY OF THE INVENTION

Briefly, therefore the present invention is directed to a novel5(S)-(2′-hydroxyethoxy)-20(S)-camptothecin diastereoisomer which issubstantially free of 5(R)-(2′-hydroxyethoxy)-20(S)-camptothecindiastereoisomer.

The present invention is also directed to a novel method of inhibitingthe activity of topoisomerase I in a cell, the method comprisingadministering to the cell a topoisomerase I inhibiting effective amountof 5(S)-(2′-hydroxyethoxy)-20(S)-camptothecin which is substantiallyfree of 5(R)-(2′-hydroxyethoxy)-20(S)-camptothecin.

The present invention is also directed to a novel pharmaceuticalcomposition comprising the 5(S)-(2′-hydroxyethoxy)-20(S)-camptothecin asdescribed above and a pharmaceutically acceptable carrier.

The present invention is also directed to a novel method of using5(S)-(2′-hydroxyethoxy)-20(S)-camptothecin for the production of apharmaceutical composition, the method comprising intermixing the5(S)-(2′-hydroxyethoxy)-20(S)-camptothecin described above with apharmaceutically acceptable carrier.

The present invention is also directed to a novel method of making the5(S)-(2′-hydroxyethoxy)-20(S)-camptothecin described above, the methodcomprising the steps:

a) intermixing 5(RS)-(2′-hydroxyethoxy)-20(S)-camptothecin with asolvent selected from n-butanol or tetrahydrofuran;

b) refluxing the mixture for a period of from about 1 to about 4 hours;

c) cooling the mixture to a temperature of from about 40° C. to about50° C.; and

d) separating solid 5(S)-(2′-hydroxyethoxy)-20(S)-camptothecin from themixture.

The present invention is also directed to a novel method of using5(S)-(2′-hydroxyethoxy)-20(S)-camptothecin to treat cancer in a subject,the method comprising administering to the subject an effective amountof the 5(S)-(2′-hydroxyethoxy)-20(S)-camptothecin described above.

Among the several advantages found to be achieved by the presentinvention, therefore, may be noted the provision of a method andcomposition to provide the benefits of camptothecin in the treatment ofcancer while reducing or avoiding one or more of the undesirable sideeffects or disadvantages that has heretofore limited its usefulness.

BRIEF DESCRIPTION OF THE DRAWINGS

FIG. 1 shows an HPLC chromatogram of one sample of5(S)-(2′-hydroxyethoxy)-20(S)-camptothecin; and

FIG. 2 shows an HPLC chromatogram of another sample of5(S)-(2′-hydroxyethoxy)-20(S)-camptothecin.

DETAILED DESCRIPTION OF THE PREFERRED EMBODIMENTS

In accordance with the present invention, it has been discovered thatthe 5(S)-(2′-hydroxyethoxy)-20(S)-camptothecin diastereoisomer is asignificantly better inhibitor of topoisomerase I than either thediastereoisomeric mixture 5(RS)-(2′-hydroxyethoxy)-20(S)-camptothecin orthe 5(R)-(2′-hydroxyethoxy)-20(S)-camptothecin diastereoisomer. In fact,5(S)-(2′-hydroxyethoxy)-20(S)-camptothecin is over 20-fold more potentthan 5(R)-(2′-hydroxyethoxy)-20(S)-camptothecin and almost 12-fold morepotent than the diastereoisomeric mixture5(RS)-(2′-hydroxyethoxy)-20(S)-camptothecin.

Furthermore, the 5(S)-(2′-hydroxyethoxy)-20(S)-camptothecindiastereoisomer has been shown to be a better inhibitor of the growth oftumors and of cancerous cells than either the diastereoisomeric mixture5(RS)-(2′-hydroxyethoxy)-20(S)-camptothecin, or the5(R)-(2′-hydroxyethoxy)-20(S)-camptothecin diastereoisomer.

Unexpectedly, however, the increased anti-cancer activity of the5(S)-(2′-hydroxyethoxy)-20(S)-camptothecin diastereoisomer is notaccompanied by a commensurate increase in toxicity to normal humancells. In fact, when the in vitro potency of the5(S)-(2′-hydroxyethoxy)-20(S)-camptothecin5(S)-(2′-hydroxyethoxy)-20(S)-camptothecindiastereoisomer against cancer cell lines is compared with its in vitrotoxicity in healthy human cells, it is found that the safety margin(Gl₉₀/Gl₅₀) is over twice that of the5(R)-(2′-hydroxyethoxy)-20(S)-camptothecin diastereoisomer.

Moreover, the presence of the 5(R)-(2′-hydroxyethoxy)-20(S)-camptothecindiastereoisomer has a negative effect on the bioavailability of the5(S)-(2′-hydroxyethoxy)-20(S)-camptothecin diastereoisomer.Consequently, it is advantageous to administer the5(S)-(2′-hydroxyethoxy)-20(S)-camptothecin diastereoisomer that issubstantially free of the 5(R)-(2′-hydroxyethoxy)-20(S)-camptothecindiastereoisomer to a subject for the treatment of cancer.

To describe the present invention, certain terms are defined herein asfollows.

The terms “5(S)-(2′-hydroxyethoxy)-20(S)-camptothecin” is intended tocover not only the more active lactone form of5(S)-(2′-hydroxyethoxy)-20(S)-camptothecin, but also the less activecarboxylate form, including any salts formed therefrom.

The term “inhibit” and variations thereof refer to any reduction of acellular activity, such as topoisomerase I activity, which can bemeasured via methods described herein.

The terms “pharmaceutically acceptable”, which are further definedbelow, refer to those active agents, hydrates, solvates, salts,polymorphs, carriers, and the like, which are, within the scope of soundmedical judgment, suitable for use in contact with the tissues of humansand lower animals without undue toxicity, irritation, allergic responseand the like, commensurate with a reasonable benefit/risk ratio, andeffective for their intended use.

The term “individual”, “subject” and “patient”, as used herein, andwhich are further defined in more detail below, refer to any animal forwhom diagnosis, treatment, or therapy is desired. The term “animals” asused herein refers to humans and other mammals, as well as otheranimals.

The terms “treating” and “treatment” of a state, disorder, disease orcondition as used herein refer to (1) preventing or delaying theappearance of clinical symptoms of the state, disorder, disease orcondition developing in a patient that may be afflicted with orpredisposed to the state, disorder, disease or condition but does notyet experience or display clinical or subclinical symptoms of the state,disorder or condition, (2) inhibiting the state, disorder, disease orcondition, i.e., arresting or reducing the development of the disease orat least one clinical or subclinical symptom thereof, or (3) relievingthe disease, i.e., causing regression of the state, disorder orcondition or at least one of its clinical or subclinical symptoms. Thebenefit to a patient to be treated is either statistically significantor at least perceptible to the patient and/or to the physician.

The terms “effective amount” and “therapeutically effective amount”, asused herein, and which are further defined in more detail below, referto the amount of a compound that, when administered to a patient fortreating a state, disorder, disease or condition, is sufficient toeffect such treatment. The effective amount or therapeutically effectiveamount will vary depending on the compound, the disease and itsseverity, and the age, weight, physical condition and responsiveness ofthe individual to be treated.

The terms “delivering” and “administering”, as used herein, and whichare further defined in more detail below, refer to providing atherapeutically effective amount of an active agent to a particularlocation or locations within a patient causing a therapeuticallyeffective concentration of the active ingredient at the particularlocation or locations. This can be accomplished, e.g., by local or bysystemic administration of the active ingredient to the host, as will bediscussed in more detail below.

The term “composition”, as used herein, refers to a product comprisingthe specified agent or agents, as well as any product, which results,directly or indirectly, from combination of the specified ingredients. A“pharmaceutical composition”, which is described in more detail below,is intended to include the combination of an active agent or agents withone or more pharmaceutically acceptable carriers, inert or active,making the composition suitable for diagnostic or therapeutic use invivo, in vitro or ex vivo. The compositions can also includestabilizers, preservatives, adjuvants, fillers, flavors and otherexcipients.

As used herein in reference to camptothecin, the terms “Carbon-5position” refer to the carbon atom present at the 5^(th) position of thechemical structure of 5(S)-(2-hydroxyethoxy)-20(S)-camptothecin as shownin formula II above, and the terms “Carbon-20 position” refer to thecarbon atom present at the 20^(th) position of the chemical structure of5(S)-(2-hydroxyethoxy)-20(S)-camptothecin as shown in formula II.

As used herein, throughout the present description“5(S)-(2′-hydroxyethoxy)-20(S)-camptothecin” refers to“5(S)-(2′-hydroxyethoxy)-20(S)-camptothecin”, which is chemically knownas“4(S)-Ethyl-4-hydroxy-12(S)-(2-hydroxyethoxy)-1,12-dihydro-4H-2-oxa-6,12a-diaza-dibenzo[b,h]fluorine-3,13-dione”.

As used herein, throughout the present description“5(R)-(2′-hydroxyethoxy)-20(S)-camptothecin” refers to“5(R)-(2′-hydroxyethoxy)-20(S)-camptothecin”, which is chemically knownas“4(S)-Ethyl-4-hydroxy-12(R)-(2-hydroxyethoxy)-1,12-dihydro-4H-2-oxa-6,12a-diaza-dibenzo[b,h]fluorine-3,13-dione”.

As used herein, throughout the present description“5(RS)-(2′-hydroxyethoxy)-20(S)-camptothecin” refers to“5(RS)-(2′-hydroxyethoxy)-20(S)-camptothecin” or“5-(2′-hydroxyethoxy)-20(S)-camptothecin”, which is chemically known as“4(S)-Ethyl-4-hydroxy-12(RS)-(2-hydroxyethoxy)-1,12-dihydro-4H-2-oxa-6,12a-diaza-dibenzo[b,h]fluorine-3,13-dione”.

As used herein, the term “about”, when referring to a measured quantity,refers to the normal variation in that measured quantity as would beexpected by the skilled person making the measurement and exercising alevel of care commensurate with the objective of measurement and theprecision of the measuring equipment.

The terms “substantially free from” are defined below.

Example 26 of the '439 patent described the preparation of5-(2′-hydroxyethoxy)-20(S)-camptothecin, which is a mixture of R- andS-diastereomers, namely, 5(R)-(2′-hydroxyethoxy)-20(S)-camptothecin and5(S)-(2′-hydroxyethoxy)-20(S)-camptothecin, respectively. It has nowbeen discovered that 5(S)-(2′-hydroxyethoxy)-20(S)-camptothecin hascertain unexpectedly improved properties in comparison to5(R)-(2′-hydroxyethoxy)-20(S)-camptothecin and5(RS)-(2′-hydroxyethoxy)-20(S)-camptothecin. As discussed briefly above,the inventors have found that 5(S)-(2′-hydroxyethoxy)-20(S)-camptothecindiffers from the diastereomeric mixture5(RS)-(2′-hydroxyethoxy)-20(S)-camptothecin in several importantcharacteristics, including, for example, toxicity, in vivo anti-tumoractivity, bioavailability and topoisomerase I inhibition. Furthermore,it has now been also discovered that5(S)-(2′-hydroxyethoxy)-20(S)-camptothecin substantially free from5(R)-(2′-hydroxyethoxy)-20(S)-camptothecin is a desirable anti-cancerpharmaceutical compound.

One aspect of the present invention is5(S)-(2′-hydroxyethoxy)-20(S)-camptothecin which is substantially freeof 5(R)-(2′-hydroxyethoxy)-20(S)-camptothecin.

When it is said that the 5(S)-(2′-hydroxyethoxy)-20(S)-camptothecin issubstantially free of 5(R)-(2′-hydroxyethoxy)-20(S)-camptothecin it ismeant that the amount of 5(R)-(2′-hydroxyethoxy)-20(S)-camptothecin thatis present in a compound comprising both5(S)-(2′-hydroxyethoxy)-20(S)-camptothecin and5(R)-(2′-hydroxyethoxy)-20(S)-camptothecin is less than about 2% byweight of the total amount of 5(S)-(2′-hydroxyethoxy)-20(S)-camptothecinand 5(R)-(2′-hydroxyethoxy)-20(S)-camptothecin that is present. Theamount of 5(R)-(2′-hydroxyethoxy)-20(S)-camptothecin can be less thanabout 1.5% w/w, or it can be less than about 1%, and it can be less thanabout 0.5%, or even less than 0.1% W/W.

In a variant of this aspect, the present compound is substantiallyoptically pure. In an embodiment of this aspect, the compound hasoverall chemical purity of over 98%.

In another embodiment of the present invention, there is provided5(S)-(2′-hydroxyethoxy)-20(S)-camptothecin containing less than about1.5% of the camptothecin heterodimer shown in formula V, or it cancontain less than about 1% of the heterodimer of formula V, or less thanabout 0.8% of the heterodimer, or even less than about 0.5% of theheterodimer, and even less than about 0.1% of the heterodimer, all on aw/w basis.

In another aspect, there is provided a process for preparing5(S)-(2′-hydroxyethoxy)-20(S)-camptothecin that is substantially free of5(R)-(2′-hydroxyethoxy)-20(S)-camptothecin. The method comprises thesteps of:

a) providing a solution and/or suspension of5(RS)-(2′-hydroxyethoxy)-20(S)-camptothecin in an organic solvent inwhich said 5(S)-(2′-hydroxyethoxy)-20(S)-camptothecin has lowersolubility than said 5(R)-(2′-hydroxyethoxy)-20(S)-camptothecin(n-butanol or tetrahydrofuran can be used);

b) heating the solution and/or suspension;

c) cooling the solution and/or suspension so that a precipitate isformed; and

d) isolating the precipitate to yield said5(S)-(2′-hydroxyethoxy)-20(S)-camptothecin substantially free from5(R)-(2′-hydroxyethoxy)-20(S)-camptothecin.

The process may include the heating step that comprises refluxing thesolution and/or suspension. The process may further comprise refluxingthe isolated precipitate with additional portions of the organicsolvent.

In particular, the method of making the5(S)-(2′-hydroxyethoxy)-20(S)-camptothecin can comprise the steps:

a) intermixing 5(RS)-(2′-hydroxyethoxy)-20(S)-camptothecin with asolvent selected from n-butanol or tetrahydrofuran;

b) refluxing the mixture for a period of from about 1 to about 4 hours;

c) cooling the mixture to a temperature of from about 40° C. to about50° C.;

d) separating solid 5(S)-(2′-hydroxyethoxy)-20(S)-camptothecin from themixture.

If a purer 5(S)-(2′-hydroxyethoxy)-20(S)-camptothecin product isdesired, the method can further comprise the steps:

e) washing the solid 5(S)-(2′-hydroxyethoxy)-20(S)-camptothecin with asolvent selected from n-butanol or tetrahydrofuran; and

d) drying the solid 5(S)-(2′-hydroxyethoxy)-20(S)-camptothecin to yield5(S)-(2′-hydroxyethoxy)-20(S)-camptothecin that is substantially free of5(R)-(2′-hydroxyethoxy)-20(S)-camptothecin.

In another aspect, the invention embraces a method for inhibitingtopoisomerase I activity in a cell comprising administering to the cellan amount of 5(S)-(2′-hydroxyethoxy)-20(S)-camptothecin which issubstantially free from 5(R)-(2′-hydroxyethoxy)-20(S)-camptothecin,wherein the amount is sufficient to inhibit topoisomerase I (a“topoisomerase I inhibiting effective amount”). The target cell may becancerous and the administration may be carried out in vitro or in vivo.

The inventors have found that 5(S)-(2′-hydroxyethoxy)-20(S)-camptothecindiffers from the diastereomeric mixture5(RS)-(2′-hydroxyethoxy)-20(S)-camptothecin in several importantcharacteristics, including, for example, toxicity, in vivo anti-tumoractivity, bioavailability and topoisomerase I inhibition. Furthermore,it has now been also discovered that5(S)-(2′-hydroxyethoxy)-20(S)-camptothecin which is substantially freefrom 5(R)-(2′-hydroxyethoxy)-20(S)-camptothecin is a desirableanti-cancer pharmaceutical compound.

In the present invention, 5(S)-(2′-hydroxyethoxy)-20(S)-camptothecin isadministered to a subject according to standard routes of drug deliverythat are well known to one of ordinary skill in the art for the purposeof treating cancer.

The 5(S)-(2′-hydroxyethoxy)-20(S)-camptothecin can be supplied as a purecompound, or in the form of a pharmaceutically active salt. Illustrativepharmaceutically acceptable salts are prepared from formic, acetic,propionic, succinic, glycolic, gluconic, lactic, malic, tartaric,citric, ascorbic, glucuronic, maleic, fumaric, pyruvic, aspartic,glutamic, benzoic, anthranilic, mesylic, stearic, salicylic,p-hydroxybenzoic, phenylacetic, mandelic, embonic (pamoic),methanesulfonic, ethanesulfonic, benzenesulfonic, pantothenic,toluenesulfonic, 2-hydroxyethanesulfonic, sulfanilic,cyclohexylaminosulfonic, algenic, b-hydroxybutyric, galactaric andgalacturonic acids.

Suitable pharmaceutically-acceptable base addition salts of compounds ofthe present invention include metallic ion salts and organic ion salts.More preferred metallic ion salts include, but are not limited toappropriate alkali metal (group Ia) salts, alkaline earth metal (groupIIa) salts and other physiological acceptable metal ions. Such salts canbe made from the ions of aluminum, calcium, lithium, magnesium,potassium, sodium and zinc. Preferred organic salts can be made fromtertiary amines and quaternary ammonium salts, including in part,trimethylamine, diethylamine, N,N′-dibenzylethylenediamine,chloroprocaine, choline, diethanolamine, ethylenediamine, meglumine(N-methylglucamine) and procaine. All of the above salts can be preparedby those skilled in the art by conventional means from the correspondingcompound of the present invention.

The present 5(S)-(2′-hydroxyethoxy)-20(S)-camptothecin can be providedin a pharmaceutically acceptable carrier and excipient (wherein all“carriers” and “excipients” can be described by either term) to form apharmaceutical composition. Pharmaceutically acceptable carriers andexcipients include, but are not limited to, physiological saline,Ringer's solution, phosphate solution or buffer, buffered saline andother carriers known in the art. Pharmaceutical compositions may alsoinclude stabilizers, anti-oxidants, colorants, and diluents.Pharmaceutically acceptable carriers and additives are chosen such thatside effects from the pharmaceutical compound are minimized and theperformance of the compound is not canceled or inhibited to such anextent that treatment is ineffective.

In an embodiment of the present invention, the pharmaceuticalcomposition containing 5(S)-(2′-hydroxyethoxy)-20(S)-camptothecin isoptionally substantially free of5(R)-(2′-hydroxyethoxy)-20(S)-camptothecin.

The pharmaceutical composition typically contains from 0.1 to 50% w/w,preferably 1 to 20% w/w, of active5(S)-(2′-hydroxyethoxy)-20(S)-camptothecin compound, the remainder ofthe composition being the pharmaceutically acceptable carrier orcarriers, diluents or solvents. Preferably, the pharmaceuticalcomposition is in a unit dosage form containing appropriate quantitiesof the active compound, e.g., an amount effective to achieve the desiredpurpose.

The present pharmaceutical compositions may be administered enterallyand/or parenterally. Oral (intra-gastric) is a preferred route ofadministration. Pharmaceutically acceptable carriers can be in soliddosage forms for the methods of the present invention, which includetablets, capsules, pills, and granules, which can be prepared withcoatings and shells, such as enteric coatings and others well known inthe art. Liquid dosage forms for oral administration includepharmaceutically acceptable emulsions, solutions, suspensions, syrups,and elixirs.

Parenteral administration includes subcutaneous, intramuscular,intradermal, intramammary, intravenous, and other administrative methodsknown in the art. Enteral administration includes solution, tablets,sustained release capsules, enteric coated capsules, and syrups. Whenadministered, the pharmaceutical composition may be at or near bodytemperature.

Compositions intended for oral use may be prepared according to anymethod known in the art for the manufacture of pharmaceuticalcompositions and such compositions may contain one or more agentsselected from the group consisting of sweetening agents, flavoringagents, coloring agents and preserving agents in order to providepharmaceutically elegant and palatable preparations. Tablets contain theactive ingredient in admixture with non-toxic pharmaceuticallyacceptable excipients, which are suitable for the manufacture oftablets. These excipients may be, for example, inert diluents, such ascalcium carbonate, sodium carbonate, lactose, calcium phosphate orsodium phosphate, granulating and disintegrating agents, for example,maize starch, or alginic acid, binding agents, for example starch,gelatin or acacia, and lubricating agents, for example magnesiumstearate, stearic acid, or talc. The tablets may be uncoated or they maybe coated by known techniques to delay disintegration and absorption inthe gastrointestinal tract and thereby provide a sustained action over alonger period. For example, a time delay material such as glycerylmonostearate or glyceryl distearate may be employed.

Formulations for oral use may also be presented as hard gelatin capsuleswherein the 5(S)-(2′-hydroxyethoxy)-20(S)-camptothecin is mixed with aninert solid diluent, for example, calcium carbonate, calcium phosphateor kaolin, or as soft gelatin capsules wherein the active ingredientsare present as such, or mixed with water or an oil medium, for example,peanut oil, liquid paraffin, or olive oil.

Aqueous suspensions can be produced that contain the5(S)-(2′-hydroxyethoxy)-20(S)-camptothecin in a mixture with excipientssuitable for the manufacture of aqueous suspensions. Such excipients aresuspending agents, for example, sodium carboxymethylcellulose,methylcellulose, hydroxypropylmethyl-cellulose, sodium alginate,polyvinylpyrrolidone gum tragacanth and gum acacia; dispersing orwetting agents may be naturally-occurring phosphatides, for examplelecithin, or condensation products of an alkylene oxide with fattyacids, for example polyoxyethylene stearate, or condensation products ofethylene oxide with long chain aliphatic alcohols, for exampleheptadecaethyleneoxycetanol, or condensation products of ethylene oxidewith partial esters derived from fatty acids and a hexitol such aspolyoxyethylene sorbitol monooleate, or condensation products ofethylene oxide with partial esters derived from fatty acids and hexitolanhydrides, for example polyoxyethylene sorbitan monooleate.

The aqueous suspensions may also contain one or more preservatives, forexample, ethyl or n-propyl p-hydroxybenzoate, one or more coloringagents, one or more flavoring agents, or one or more sweetening agents,such as sucrose or saccharin.

Oily suspensions may be formulated by suspending the5(S)-(2′-hydroxyethoxy)-20(S)-camptothecin in an omega-3 fatty acid, avegetable oil, for example, arachis oil, olive oil, sesame oil orcoconut oil, or in a mineral oil such as liquid paraffin. The oilysuspensions may contain a thickening agent, for example beeswax, hardparaffin or cetyl alcohol.

Dispersible powders and granules suitable for preparation of an aqueoussuspension by the addition of water provide the5(S)-(2′-hydroxyethoxy)-20(S)-camptothecin in admixture with adispersing or wetting agent, a suspending agent and one or morepreservatives. Suitable dispersing or wetting agents and suspendingagents are exemplified by those already mentioned above. Additionalexcipients, for example sweetening, flavoring and coloring agents, mayalso be present.

The 5(S)-(2′-hydroxyethoxy)-20(S)-camptothecin and compositionscomprising the same can also be administered parenterally, eithersubcutaneously, or intravenously, or intramuscularly, or intrasternally,or by infusion techniques, in the form of sterile injectable aqueous orolagenous suspensions. Such suspensions may be formulated according tothe known art using those suitable dispersing of wetting agents andsuspending agents which have been mentioned above or other acceptableagents. The sterile injectable preparation may also be a sterileinjectable solution or suspension in a non-toxic parenterally acceptablediluent or solvent, for example as a solution in 1,3-butanediol. Amongthe acceptable vehicles and solvents that may be employed are water,Ringer's solution and isotonic sodium chloride solution. In addition,sterile, fixed oils are conventionally employed as a solvent orsuspending medium. For this purpose, any bland fixed oil may beemployed, including synthetic mono- or diglycerides. In addition, n-3polyunsaturated fatty acids may find use in the preparation ofinjectables.

Administration can also be by inhalation, in the form of aerosols orsolutions for nebulizers, or rectally, in the form of suppositoriesprepared by mixing the drug with a suitable non-irritating excipientwhich is solid at ordinary temperature, but liquid at the rectaltemperature and will therefore, melt in the rectum to release the drug.Such materials are cocoa butter and polyethylene glycols.

Also encompassed by the present invention is buccal or “sub-lingual”administration, which includes lozenges or a chewable gum comprising thecompounds, set forth herein. The compounds can be deposited in aflavored base, usually sucrose, and acacia or tragacanth, and pastillescomprising the compounds in an inert base such as gelatin and glycerinor sucrose and acacia.

Topical delivery systems are also encompassed by the present inventionand include ointments, powders, sprays, creams, jellies, collyriums,solutions or suspensions.

Powders have the advantage of sticking to moist surfaces, andconsequently, can remain active for longer periods. Therefore, powdersare especially attractive for treating cancers in, for example the oticcanal. For much the same reason, creams are also effectivepharmaceutically acceptable carriers.

The compositions of the present invention can optionally be supplementedwith additional agents such as, for example, viscosity enhancers,preservatives, surfactants and penetration enhancers.

Such viscosity-building agents include, for example, polyvinyl alcohol,polyvinyl pyrrolidone, methylcellulose, hydroxy propyl methylcellulose,hydroxyethyl cellulose, carboxymethyl cellulose, hydroxy propylcellulose or other agents know to those skilled in the art. Such agentsare typically employed at a level of from 0.01% to 2% by weight.

Preservatives are optionally employed to prevent microbial contaminationduring use. Suitable preservatives include: polyquarternium-1,benzalkonium chloride, thimerosal, chlorobutanol, methyl paraben, propylparaben, phenylethyl alcohol, edetate disodium, sorbic acid, or otheragents known to those skilled in the art. The use of polyquarternium-1as the antimicrobial preservative is preferred. Typically, suchpreservatives are employed at a level of from 0.001% to 1.0% by weight.

The solubility of the components of the present compositions may beenhanced by a surfactant or other appropriate co-solvent in thecomposition. Such co-solvents include polysorbate 20, 60, and 80,polyoxyethylene/polyoxypropylene surfactants (e.g. Pluronic F-68, F-84and P-103), cyclodextrin, or other agents known to those skilled in theart. Typically, such co-solvents are employed at a level of from 0.01%to 2% by weight.

Pharmaceutically acceptable excipients and carriers encompass all theforegoing and the like. The above considerations concerning effectiveformulations and administration procedures are well known in the art andare described in standard textbooks. See e.g. Gennaro, A. R., Remington:The Science and Practice of Pharmacy, 20th Edition, (Lippincott,Williams and Wilkins), 2000; Hoover, John E., Remington's PharmaceuticalSciences, Mack Publishing Co., Easton Pa., 1975; Liberman, et al., Eds.,Pharmaceutical Dosage Forms, Marcel Decker, New York, N.Y., 1980; andKibbe, et al., Eds., Handbook of Pharmaceutical Excipients (3rd Ed.),American Pharmaceutical Association, Washington, 1999.

For purposes of the present invention, it is preferred that the amountof 5(S)-(2′-hydroxyethoxy)-20(S)-camptothecin comprises an effectiveamount of the compound. Thus, the present invention encompasses a methodof preventing or treating cancer, neoplasia, and/or a neoplasia-relateddisease or disorder (which together will be referred to herein as“cancer”), where such treatment preferably is administered to a subjectin need of such prevention or treatment, the method comprisingadministering an effective amount of the5(S)-(2′-hydroxyethoxy)-20(S)-camptothecin as described herein to asubject.

In determining the effective amount or dose of5(S)-(2′-hydroxyethoxy)-20(S)-camptothecin, a number of factors areconsidered by the attending diagnostician, including, but not limitedto, the potency and duration of action of the compounds used, the natureand severity of the illness to be treated, as well as the sex, age,weight, general health and individual responsiveness of the patient tobe treated, and other relevant circumstances. It will be appreciatedthat the amount of the 5(S)-(2′-hydroxyethoxy)-20(S)-camptothecinrequired for use in the treatment or prevention of cancer will varywithin wide limits and will be adjusted to the individual requirementsin each particular case.

For any compound, the therapeutically effective dose can be estimatedinitially either in cell culture or in animal models. Thetherapeutically effective dose refers to the amount of active compoundthat ameliorates the condition or its symptoms. Therapeutic efficacy andtoxicity in cell cultures or animal models may be determined by standardpharmaceutical procedures (e.g., ED₅₀: the dose therapeuticallyeffective in 50% of the population; LD₅₀: the dose lethal to 50% of thepopulation). The data obtained from cell culture and animal models canthen be used to formulate a range of dosage for the compound for use inpatients.

In general, for administration to adults, an appropriate daily dosage isdescribed herein, although the limits that are identified as beingpreferred may be exceeded if expedient. The daily dosage can beadministered as a single dosage or in divided dosages. Those skilled inthe art will appreciate that dosages may also be determined withguidance from Goodman & Goldman's The Pharmacological Basis ofTherapeutics, Ninth Edition (1996), Appendix II, pp. 1707-1711. Atypical recommended daily dosage regimen will generally range from about0.01 mg/kg/day to about 50 mg/kg/day, or from about 0.05 mg/kg/day toabout 25 mg/kg/day, or from about 0.1 mg/kg/day to about 10 mg/kg/day,or from about 0.1 mg/kg/day to about 5 mg/kg/day, or even from about 0.2mg/kg/day to about 3 mg/kg/day.

In one embodiment, the crystalline 5(S)-CPT can be provided as hardgelatin capsules for oral administration containing from about 1 mg toabout 1000 mg of 5(S)-CPT per capsule, or from about 2 mg to about 500mg, or from about 5 mg to about 250 mg of 5(S)-CPT per capsule. When thesubject to which the 5(S)-CPT is administered is an adult human, thedaily dosage of the 5(S)-CPT can be from about 0.01 mg/kg/day to about50 mg/kg/day, or from about 0.05 mg/kg/day to about 25 mg/kg/day, orfrom about 0.1 mg/kg/day to about 10 mg/kg/day, or from about 0.1mg/kg/day to about 5 mg/kg/day, or even from about 0.2 mg/kg/day toabout 3 mg/kg/day.

As used herein, the term “subject” for purposes of treatment includesany subject, and preferably is a subject who is in need of the treatmentof cancer. As used herein, the terms “subject in need of” refer to anysubject who is suffering from or is predisposed to cancer. The terms“subject in need of” also refer to any subject that requires a lowerdose of conventional cancer treatment agents. In addition, the terms“subject in need of” means any subject who requires a reduction in theside-effects of a conventional treatment agent. Furthermore, the terms“subject in need of” means any subject who requires improvedtolerability to any conventional treatment agent for cancer therapy.

The subject is typically an animal, and yet more typically is a mammal.“Mammal”, as that term is used herein, refers to any animal classifiedas a mammal, including humans, domestic and farm animals, zoo, sports,or pet animals, such as dogs, horses, cats, cattle, etc. The subject mayalso be a human subject who is at risk for developing cancer or at riskfor a relapse of cancer.

The methods and compositions of the present invention may be used forthe treatment or prevention of several cancers including, but notlimited to, ovarian cancer, osteosarcoma, leukemia, lymphoma, small celllung cancer, non-small cell lung cancer, central nervous system (CNS)cancer, breast cancer, colorectal cancer, renal cancer, bladder cancer,breast cancer, epidermoid cancer, lung cancer, melanoma, prostatecancer, uterine cancer, soft tissue sarcoma, pancreatic cancer andrhabdomyosarcoma.

The compounds and preparations of the present invention can also be usedfor the treatment of colon cancer, ovarian cancer and osteosarcoma.

The compounds and preparations of the present invention can also be usedfor the treatment of osteosarcoma, colorectal cancer and pancreaticcancer.

The following examples describe preferred embodiments of the invention.Other embodiments within the scope of the claims herein will be apparentto one skilled in the art from consideration of the specification orpractice of the invention as disclosed herein. It is intended that thespecification, together with the examples, be considered to be exemplaryonly, with the scope and spirit of the invention being indicated by theclaims which follow the examples. In the examples all percentages aregiven on a weight basis unless otherwise indicated.

EXAMPLE 1

This example shows the improved topoisomerase I inhibition activity of5(S)-(2′-hydroxyethoxy)-20(S)-camptothecin as compared against the5(RS)-(2′-hydroxyethoxy)-20(S)-camptothecin diastereoisomeric mixtureand against the 5(R)-(2′-hydroxyethoxy)-20(S)-camptothecindiastereoisomer.

Preparation of 5(S)-(2′-hydroxyethoxy)-20(S)-camptothecin,5(R)-(2′-hydroxyethoxy)-20(S)-camptothecin and5(RS)-(2′-hydroxyethoxy)-20(S)-camptothecin

A diastereoisomeric mixture of5(RS)-(2′-hydroxyethoxy)-20(S)-camptothecin (75 grams) prepared asdescribed in Example-26 of U.S. Pat. No. 6,177,439, was suspended inn-butanol (about 600 ml) and refluxed over a period of about 2-3 hours.The reaction mass temperature was reduced over a period of about 1 hourto about 40-50° C., and the solid material obtained was filtered, washedwith n-butanol (about 15-20 ml) and dried under vacuum at about 50-55°C. to yield solid 5(S)-(2′-hydroxyethoxy)-20(S)-camptothecinsubstantially free of 5(R)-(2′-hydroxyethoxy)-20(S)-camptothecin. Theproduct was further enriched to yield5(S)-(2′-hydroxyethoxy)-20(S)-camptothecin that was substantially freeof 5(R)-(2′-hydroxyethoxy)-20(S)-camptothecin by repeatedly refluxing inn-butanol (generally 2-4 times; yield 25-35 grams).

5(R)-(2′-hydroxyethoxy)-20(S)-camptothecin was isolated from the motherliquor by dropwise addition of n-heptane followed by filtration using a10μ Nutche filter.

5(RS)-(2′-hydroxyethoxy)-20(S)-camptothecin (diastereoisomeric mixture)was obtained as described in Example 26 of U.S. Pat. No. 6,177,439.

Topoisomerase I Assay:

Topoisomerase I introduces transient nicks in DNA at specific sites.Detection of these transient DNA nicks requires trapping the enzyme onDNA in a nicked intermediate complex using protein denaturants. Theresulting covalent DNA/top I complexes contain nicked open circular DNAwhich can be detected by agarose gel electrophoresis (with ethidiumbromide). Trapping nicked intermediates is relatively inefficient,however, inhibitors, such as the natural product camptothecin, stabilizethe intermediate and lead to an increase in the nicked DNA product. Thisforms the basis for a mechanistic drug screen designed to allowdetection of agents that affect topoisomerase I by stabilizing thecleaved intermediate complex.

The TopoGEN® Topo I Drug Screening Kit (Topogen, Inc., Port Orange,Fla.) is designed to allow the investigator to quickly identify novelinhibitors of topoisomerase I. The kit allows the detection of novelcompounds that either stabilize the nicked intermediate or otherwiseinhibit catalytic activity of topoisomerase I. Assay KIT used: Topogen ®Drug screening kit, Manufacturer: TOPOGEN, Cat No: 1018. Each reactionmix contains: a. 10× Reaction buffer 2 μl b. TOPO I enzyme 2 μl c. pHOTI DNA 1.2 μl (0.5 ug) d. Water 14.8 μl e. Drug in DMSO 1 μl Total 20 μlProtocol

The above reaction mixture is incubated at 37° C. for 30 minutes. Thereaction is terminated by adding 2 μl of 10% SDS and the mixture isvortexed rapidly (SDS should be added while at 37° C. as cooling thetubes might reseal the nicked DNA). 10× Dye, about 2.5 μl per tube, isadded and equal volumes of a mixture of chloroform and isoamyl alcohol(24:1) is added and centrifuged at 13000 rpm for 10 minutes. Samples areloaded on a 1% agarose gel and electrophoresed for 1 hour at 80 volts.The gel was viewed on UV transilluminator and the densitometricestimation of the bands was calculated.

Calculations:

The density of the DNA bands of both super coiled and relaxed forms ofDNA was measured using the densitometer. The band intensity of treated(with single concentration of the test drug) and without the drug (i.e.,the Control) were recorded. The percentage of relaxed form DNA comparedto the supercoiled DNA was calculated for all the lanes includingtreated and control.

% inhibition of Topoisomerase activity was calculated as:=(100−(100×(1/%inhibition in Control)×%inhibition in treated))

Table I shows the results of these tests and shows the in vitrotopoisomerase I activities of 5(S)-(2′-hydroxyethoxy)-20(S)-camptothecinand 5(R)-(2′-hydroxyethoxy)-20(S)-camptothecin, which were substantiallyfree of each other, compared with the activity of the racemic mixture5(RS)-(2′-hydroxyethoxy)-20(S)-camptothecin. TABLE 1 Topoisomerase Iactivity of 5(S)-(2′-hydroxyethoxy)-20(S)- camptothecin,5(R)-(2′-hydroxyethoxy)-20(S)-camptothecin and5(RS)-(2′-hydroxyethoxy)-20(S)-camptothecin. COMPOUND IC₅₀(μM)5(S)-(2′-hydroxyethoxy)-20(S)-camptothecin 1.065(R)-(2′-hydroxyethoxy)-20(S)-camptothecin 225(RS)-(2′-hydroxyethoxy)-20(S)-camptothecin 12.5

The results show that the 5(S)-(2′-hydroxyethoxy)-20(S)-camptothecin isabout 21-fold more active than5(R)-(2′-hydroxyethoxy)-20(S)-camptothecin and about 12 times moreactive than 5(RS)-(2′-hydroxyethoxy)-20(S)-camptothecin in inhibitingtopoisomerase I. Such differences in activity would not be expectedbased on structural differences between the diastereomers since it isknown that, particularly in view of the importance of the E-ring inenzyme activity.

EXAMPLE 2

This example shows the anti-tumor activity of5(S)-(2′-hydroxyethoxy)-20(S)-camptothecin against NCl—H460 (human smallcell lung carcinoma) xenografts in nude mice versus the activity of5(RS)-(2′-hydroxyethoxy)-20(S)-camptothecin.

Samples of 5(S)-(2′-hydroxyethoxy)-20(S)-camptothecin and5(RS)-(2′-hydroxyethoxy)-20(S)-camptothecin were provided as describedin Example 1.

Protocol of Comparison Study of5(RS)-(2′-hydroxyethoxy)-20(S)-camptothecin and5(S)-(2′-hydroxyethoxy)-20(S)-camptothecin Against NCl—H460 Xenograft inNude Mice

To perform the NCl—H460 xenograft study, NCl—H460 tumor pieces measuring˜60 mm³ were implanted in the space of dorsal lateral flanks of femaleathymic nude mice to initiate tumor growth. When the tumors were grownto ˜150-1000 mm³, animals were randomized into groups of five prior toinitiating therapy. Each gram of5(RS)-(2′-hydroxyethoxy)-20(S)-camptothecin was formulated to contain102.65 mg active compound, 801.62 mg hydroxylpropyl beta cyclodextran,80.62 mg dextrose anhydrous and 13.33 mg sodium carbonate. Each gram of5(S)-(2′-hydroxyethoxy)-20(S)-camptothecin was formulated to contain105.57 mg active compound, 800.99 mg hydroxylpropyl beta cyclodextran,80.13 mg dextrose anhydrous and 13.34 mg sodium carbonate. Each gram ofplacebo was formulated to contain 895.2 mg hydroxylpropyl betacyclodextran, 89.52 mg dextrose anhydrous and 14.9 mg sodium carbonate.Each formulation was dissolved in 2 ml sterile water and administeredthrough oral route in a (d×5)2 schedule. Tumor diameters were measuredtwice a week using a vernier caliper.

Tumor volumes were calculated assuming tumors to be ellipsoid using theformula:V=(D×d ²)/2,where V (mm³) is tumor volume, D is longest diameter in mm and d isshortest diameter in mm. Change in tumor volumes (Δ) for each treated(T) and control (C) group were calculated by subtracting the mean tumorvolume on the first day of treatment (starting day) from the mean tumorvolume on the specified observation day. These values were used tocalculate a percentage growth (% T/C) using the formulas:%T/C=(ΔT/ΔC)×100,whereΔT>0,or%T/C=(ΔT/ΔTi)×100,whereΔT<0and

Ti is the mean tumor volume.

Percentage tumor growth inhibition (% TGI) was then calculated using theformula:%TGI=100−%TC.

All of the mice bearing subcutaneous tumors measuring approximately150-800 mm³ were treated with test compound through oral gavage using a(d×5)2 schedule. Tumor diameters were measured twice in a week usingvernier calipers and tumor volumes were calculated assuming tumors to beellipsoid using the formula V=(D×d²)/2 where V (mm³) is tumor volume, Dis longest diameter in mm., and d is shortest diameter in mm. Changes intumor Volumes (Δ volumes) for each treated (T) and control (C) group arecalculated, by subtracting the mean tumor volume on the first day oftreatment (starting day) from the mean tumor volume of on the specifiedobservation day. These values are used to calculate a percentage growth(% T/C) using the formula:%T/C=(ΔT/ΔC)×100whereΔT>0or=(ΔT/ΔTi)×100whereΔT<0,where Ti is the meantumor volume at the start of treatment.

Percentage tumor growth inhibition was calculated using the formula:Percentage Tumor growth inhibition=100−% T/C.

Tumor regressions are defined as partial if the tumor volume decreasesto 50% or less of the tumor volume at the start of the treatment withoutdropping below to 63 mm³. Complete regression is defined if the tumorvolume drops to below measurable limits (<63 mm³)

The percentage body weight change in comparison to starting day bodyweight of each animal was calculated using the formula:Percentage Body weight change=[(Body weight on specified observationday−Body weight on starting day)/Body weight on starting day]×100.

The other parameter observed was mortality.

The results of the tests are shown in Table 2, where the tumor growthinhibition and the mortality is shown for each of the two test compoundsand for the control. TABLE 2 Effect of5(S)-(2′-hydroxyethoxy)-20(S)-camptothecin and5(RS)-(2′-hydroxyethoxy)-20(S)-camptothecin on tumor growth inhibitionand mortality of nude mice having NCI-H460 (human small cell lungcarcinoma) xenografts. Dose % Tumor Growth Compound (mg/kg) InhibitionMortality 5(S)-(2′-hydroxyethoxy)- 2 68 0/5 20(S)-camptothecin 4 76 0/55(RS)-(2′-hydroxyethoxy)- 2 60 0/5 20(S)-camptothecin 4 64 0/5

The data from this test showed that5(S)-(2′-hydroxyethoxy)-20(S)-camptothecin demonstrated better in vivoactivity against NCl—H460 (human small cell lung carcinoma) xenograftsin nude mice than the diastereoisomer5(RS)-(2′-hydroxyethoxy)-20(S)-camptothecin. As shown in Table 2, theadministration of 5(S)-(2′-hydroxyethoxy)-20(S)-camptothecin led tounexpected increase in the inhibition of tumor growth in comparison withthe administration of 5(RS)-(2′-hydroxyethoxy)-20(S)-camptothecin atidentical doses (68% vs 60% at 2 mg/kg, and 76% vs 64% at 4 mg/kg)without an increase in mortality.

EXAMPLE 3

This example illustrates the efficacy of5(S)-(2′-hydroxyethoxy)-20(S)-camptothecin versus5(R)-(2′-hydroxyethoxy)-20(S)-camptothecin in inhibiting in vitro cellproliferation in a Sulphorhodamine B (SRB) assay.

Samples of 5(S)-(2′-hydroxyethoxy)-20(S)-camptothecin and5(R)-(2′-hydroxyethoxy)-20(S)-camptothecin were provided as described inExample 1.

Protocol for In Vitro Cell Growth Assay:

Cell proliferation was evaluated by Sulphorhodamine B (SRB) assay wherethe amount of dye bound to the cells after staining gives a measure ofcell growth. Refer to: JNCI, vol 83, No. 11, Jun. 5, 1991, which isincorporated herein by reference.

Briefly, cells (34 human cancer cell lines represented by bladder,breast, CNS, colon, epidermoid, lung, ovarian, melanoma, prostate, renaland uterine cancers) were seeded on a 96-well cell culture plates at aconcentration of 10,000 cells per well and incubated at 37° C. in a CO₂incubator. Twenty-four hours later, cells were treated with differentconcentrations of andrographolide dissolved in DMSO to a finalconcentration of 0.05% in the culture medium and exposed for 48 h. Cellswere fixed by adding ice-cold 50% trichloroacetic acid (TCA) andincubating for 1 h at 4° C. The plates were washed with distilled water,air dried and stained with SRB solution (0.4% wt/vol in 1% Acetic acid)for 10 min at room temperature. Unbound SRB was removed by washingthoroughly with 1% acetic acid and the plates were air-dried. The boundSRB stain was solubilized with 10 mM Tris buffer, and the opticaldensities were read on a spectrophotometric plate reader at a singlewavelength of 515 nm. At the time of drug addition separate referenceplate for cell growth at time 0 h (the time at which drugs were added)was also terminated as described above. From the optical densities thepercentage growths were calculated using the following formulae:IfTis greater than or equal toT ₀,percentage growth=100×[(T−T ₀)/(C−T₀)]and ifTis less thanT ₀,percentage growth=100×[(T−T ₀)/T ₀)],

Where T is optical density of test, C is the optical density of controland T₀ is the optical density at time zero.

From the percentage growths a dose response curve was generated and Gl₅₀values were interpolated from the growth curves. Table 3 shows theresults. TABLE 3 GI50 values for5(S)-(2′-hydroxyethoxy)-20(S)-camptothecin versus5(R)-(2′-hydroxyethoxy)-20(S)-camptothecin. Compound GI₅₀(μM)5(S)-(2′-hydroxyethoxy)-20(S)-camptothecin 5.05(R)-(2′-hydroxyethoxy)-20(S)-camptothecin 14.6

The results of this test showed that the5(S)-(2′-hydroxyethoxy)-20(S)-camptothecin diastereoisomer was almostthree times more active than the5(R)-(2′-hydroxyethoxy)-20(S)-camptothecin diastereoisomer against cellproliferation in the test.

EXAMPLE 4

This example illustrates the efficacy of5(S)-(2′-hydroxyethoxy)-20(S)-camptothecin in several osteosarcoma tumormodels.

Samples of 5(S)-(2′-hydroxyethoxy)-20(S)-camptothecin and5(RS)-(2′-hydroxyethoxy)-20(S)-camptothecin were provided as describedin Example 1.

This test was carried out with the use of the methods described inCancer, Res., Oct. 15, 64:20:7491-9 (2004), and in Clin. Cancer Res.,Nov. 15:9(15):5442-53 (2003).

All mice bearing subcutaneous (“sc”) tumors measuring approximately0.2-1 cm in diameter were treated with a test compound by oral gavageusing [(d×5)2]3 schedule. Tumor diameters were measured every 7 daysusing Vernier calipers and tumor volumes were calculated, assumingtumors to be spherical, using the formula [π/6)×d³], where d is the meandiameter. The tumor response to the test compound was defined asfollows: For individual tumors, partial regression (“PR”) was defined asa volume regression>50%, but with measurable tumor at all times.Complete regression (“CR”) was defined as disappearance of measurabletumor mass at some point within 12 weeks after initiation of therapy.Maintained CR is defined as no tumor re-growth within a 12-week studytime frame. This time point was chosen because all studies lasted atleast 12 weeks. Mice that died before the end of the 12-week study time,and prior to achieving a response, were considered as failures for tumorresponse. The results (dose of 28 mg/kg) are presented in Table 4. TABLE4 Efficacy of 5(S)-(2′-hydroxyethoxy)-20(S)-camptothecin versus5(RS)-(2′-hydroxyethoxy)-20(S)-camptothecin in mouse tumor regressionmodels. 5(S)-(2′- 5(RS)-(2′- hydroxyethoxy)- hydroxyethoxy)- Xenograft20(S)-camptothecin 20(S)-camptothecin Osteosarcoma- 6+ 5+ 29Osteosarcoma- 6+ 4+ 17 Osteosarcoma- 6+ 5+ 2 Osteosarcoma- 6+ 3+ 326+: Maintained Complete Regression5+: Complete Regression4+: Partial Regression3+: Stable Disease

As shown by the date of Table 4, administration of5(S)-(2′-hydroxyethoxy)-20(S)-camptothecin led to unexpectedly improvedresults in comparison with the administration of5(RS)-(2′-hydroxyethoxy)-20(S)-camptothecin, as indicated by completeregression (6+) achieved with 5(S)-(2′-hydroxyethoxy)-20(S)-camptothecinin all four xenograft lines.

The data provided in Examples 3 and 4 illustrates that5(S)-(2′-hydroxyethoxy)-20(S)-camptothecin has unexpectedly improvedactivity/potency profile in several test models. Furthermore, while5(S)-(2′-hydroxyethoxy)-20(S)-camptothecin is substantially more potentthan 5(R)-(2′-hydroxyethoxy)-20(S)-camptothecin, the increase in potencyis not accompanied by a commensurate increase in toxicity.

EXAMPLE 5

This example shows the human bone marrow toxicity of5(S)-(2′-hydroxyethoxy)-20(S)-camptothecin versus5(R)-(2′-hydroxyethoxy)-20(S)-camptothecin.

Samples of 5(S)-(2′-hydroxyethoxy)-20(S)-camptothecin and5(R)-(2′-hydroxyethoxy)-20(S)-camptothecin were provided as described inExample 1.

Protocol for Human Bone Marrow Assay:

Methocult™ GF (Cat No: H4534, Poietics, Biowhittakar, USA) mediumcomprising Methycellulose in Iscove's MDM, Fetal bovine serum, Bovineserum albumin, 2-Mercaptoethanol, L-Glutamine, rhStem cell factor,rhGM-CSF and rhIL-3 was used for the assay. Human bone marrowmononuclear cells (Cat No. 2M-125C, Poietics, Biowhittakar, USA) weremixed with Methocult GF and the cell density was adjusted to 3×10⁵cells/ml. From this preparation, 500 μL aliquots were made and 2.5 μL of20× drug solution or vehicle was added to each aliquot and mixedthoroughly. 100 μL of clonogenic medium was plated into each well andthe plates were allowed to gel at 4° C. for 15 minutes. Plates wereincubated at 37° C. in a fully humidified atmosphere of 5% CO₂ in anincubator for 14 days. CFU-GM colonies were counted under an invertedmicroscope as aggregates of 50 cells or more. The percentage colonyinhibition was calculated using the following formula:100−[(number of colonies in drug treated wells/Number of colonies incontrol wells)×100].

The in vitro potency of the two diastereomers against cancer cell lineshad been compared with their in vitro toxicity in healthy cells. Table 5presents the results of the bone marrow toxicity comparison study inhuman cells. TABLE 5 GI₉₀ values for5(S)-(2′-hydroxyethoxy)-20(S)-camptothecin and5(R)-(2′-hydroxyethoxy)-20(S)-camptothecin for human bone marrow cellsin vitro. Compound GI₉₀(μM) 5(S)-(2′-hydroxyethoxy)-20(S)-camptothecin0.69 5(R)-(2′-hydroxyethoxy)-20(S)-camptothecin 0.89

With reference to the date shown in Tables 3 and 5, it can be seen thatwhile 5(S)-(2′-hydroxyethoxy)-20(S)-camptothecin is unexpectedly almost3 times more potent against 34 human cancer cell lines (includingbladder, breast, CNS, colon, epidermoid, lung, ovarian, melanoma,prostate, renal and uterine cancer cells) than5(R)-(2′-hydroxyethoxy)-20(S)-camptothecin, the toxicities of bothdiastereomers are comparable. In fact, if the safety margin is estimatedas the ratio of GI₉₀ for human cell toxicity to GI₅₀ for anticanceractivity, as shown in Table 6, it is apparent that5(S)-(2′-hydroxyethoxy)-20(S)-camptothecin is unexpectedly superior to5(R)-(2′-hydroxyethoxy)-20(S)-camptothecin and5(RS)-(2′-hydroxyethoxy)-20(S)-camptothecin as a pharmaceutical compoundfor treatment of cancer. Thus, the5(S)-(2′-hydroxyethoxy)-20(S)-camptothecin compound has increasedefficacy with respect to treatment of cancer in comparison with theR-diastereomer and the mixture of diastereomers. In fact, it isunexpectedly important to minimize the amount of the5(R)-(2′-hydroxyethoxy)-20(S)-camptothecin present in the5(S)-(2′-hydroxyethoxy)-20(S)-camptothecin to be given to patients.TABLE 6 Ratio of GI₉₀ for human cell toxicity to GI₅₀ for anticanceractivity for 5(S)-(2′-hydroxyethoxy)-20(S)-camptothecin and5(R)-(2′-hydroxyethoxy)-20(S)-camptothecin. Safety Margin Compound(GI₉₀/GI₅₀) 5(S)-(2′-hydroxyethoxy)-20(S)-camptothecin 0.145(R)-(2′-hydroxyethoxy)-20(S)-camptothecin 0.06

EXAMPLE 6

This example shows the effect of the presence of5(R)-(2′-hydroxyethoxy)-20(S)-camptothecin on the bioavailability of5(S)-(2′-hydroxyethoxy)-20(S)-camptothecin in rats and mice.

Samples of 5(S)-(2′-hydroxyethoxy)-20(S)-camptothecin (“5(S) —CPT”) and5(RS)-(2′-hydroxyethoxy)-20(S)-camptothecin (“5(RS)—CPT”) were providedas described in Example 1.

Bioavailability in Male Wistar Rats:

5(S)-CPT (2.5 mg/kg) and 5(RS)-CPT (5 mg/kg, including 2.5 mg/kg of5(S)-CPT in the mixture) were been administered to male Wistar Rats toevaluate oral pharmacokinetics.

Male Wistar rats, 6-8 weeks of age and weighing between 205 and 218 gwere divided into groups of four rats. The oral pharmacokinetics testwas carried out in overnight fasted condition and intravenouspharmacokinetics was carried out in fed condition. The test drugs wereadministered as a solution by oral gavage or lateral tail veininjection. Sparse blood samples of about 250 microliters were collectedfrom retro-orbital plexus at designated time points into microcentrifugetubes containing 25 microliters of EDTA. Plasma was separated bycentrifuging blood at 12,800 rpm for 2 min and refrigerated untilanalysis.

Samples were tested for the presence of the test drug as follows. Analiquot of 100 μl plasma (stored at 8° C.) was precipitated with 400 μlof cold methanol for the estimation of total (lactone+carboxylate).Following mixing for 2 min. and centrifugation for 4 min. at 12,800 rpm,clear supernatant was separated into a 300 μl auto-sampler vial and 20μl of this mixture was injected onto an analytical column for HPLCanalysis. Concentrations of the test drug were calculated from thelinearity plotted by spiking known concentrations of the test drug inblank rat plasma. The pharmacokinetics of the test drug was calculatedusing non-compartmental analysis.

The results of the study are presented in Table 7. TABLE 7 Oralpharmacokinetic parameters of 5(S)-CPT in male Wistar rats. AUC(o-t)Compound Dose μM*h 5(S)-CPT 5 mg/kg 5.76 5(RS)-CPT 5 mg/kg 5.08 (2.5mg/kg 5(S)-CPT + 2.5 mg/kg 5(R)-CPT) Contribution of 5(S)- 2.5 mg/kg  1.21 CPT in 5(RS)-CPTBioavailability in Swiss Albino Mice:

5(S)-CPT (2.5 mg/kg) and 5(RS)-CPT (5 mg/kg, including 2.5 mg/kg of5(S)-CPT in the mixture) were been administered to Swiss Albino mice toevaluate oral pharmacokinetics.

Swiss Albino mice, 3-6 weeks of age and weighing between 28-34 g wereused in the study. Twelve mice were used per study. The oralpharmacokinetics test was carried out in overnight fasted condition andintravenous pharmacokinetics was carried out in fed condition. The testdrugs were administered as a solution by oral gavage or lateral tailvein injection. Sparse blood samples of about 250 microliters werecollected from retro-orbital plexus at designated time points intomicrocentrifuge tubes containing 25 microliters of EDTA. Plasma wasseparated by centrifuging blood at 12,800 rpm for 2 min and refrigerateduntil analysis.

Samples were tested for the presence of the test drug as follows. Analiquot of 100 μl plasma (stored at 8° C.) was precipitated with 400 μlof cold methanol for the estimation of total (lactone+carboxylate).Following mixing for 2 min. and centrifugation for 4 min. at 12,800 rpm,clear supernatant was separated into a 300 μl auto-sampler vial and 20μl of this mixture was injected onto an analytical column for HPLCanalysis. Concentrations of the test drug were calculated from thelinearity plotted by spiking known concentrations of the test drug inblank rat plasma. The pharmacokinetics of the test drug was calculatedusing non-compartmental analysis. The results of the study are presentedin Table 8. TABLE 8 Oral pharmacokinetic parameters of 5(S)-CPT in SwissAlbino mice. AUC(o-t) Compound Dose μM*h 5(S)-CPT 5 mg/kg 5.18 5(RS)-CPT5 mg/kg 5.20 (2.5 mg/kg 5(S)-CPT + 2.5 mg/kg 5(R)-CPT) Contribution of5(S)- 2.5 mg/kg   1.10 CPT in 5(RS)-CPT

With reference to Tables 7 and 8, the “Contribution of5(S)-(2′-hydroxyethoxy)-20(S)-camptothecin” is the Area Under Curve(“AUC”) that can be attributed to the S-diastereomer in the RSdiastereomeric mixture. As can be seen from Tables 7 and 8, the presenceof 5(R)-(2′-hydroxyethoxy)-20(S)-camptothecin unexpectedly decreasesbioavailability of the desired 5(S) diastereomer. Moreover, it isbelieved that such unexpected decrease in bioavailability for thedesired diastereomers would also be observed in human patients. On thebasis of the above, the inventors have recognized that minimization ofthe amount of the R diastereomers impurity in5(S)-(2′-hydroxyethoxy)-20(S)-camptothecin is desirable.

EXAMPLE 7

This example illustrates the efficacy of5(S)-(2′-hydroxyethoxy)-20(S)-camptothecin versus5(R)-(2′-hydroxyethoxy)-20(S)-camptothecin and5(RS)-(2′-hydroxyethoxy)-20(S)-camptothecin against BCRP mutant andBreast cancer resistance protein (BCRP) over expressing Saos-2 cells.

Samples of 5(S)-(2′-hydroxyethoxy)-20(S)-camptothecin,5(R)-(2′-hydroxyethoxy)-20(S)-camptothecin and5(RS)-(2′-hydroxyethoxy)-20(S)-camptothecin were provided as describedin Example 1.

Protocol for Breast Cancer Resistance Protein (BCRP) Assay:

The anticancer effect of 5(S)-(2′-hydroxyethoxy)-20(S)-camptothecin &5(R)-(2′-hydroxyethoxy)-20(S)-camptothecin were evaluated versus theracemate 5(RS)-(2′-hydroxyethoxy)-20(S)-camptothecin on Saos-2 cellsover expressing functional BCRP#4 and non-functional BCRP mut#10. Thehuman osteosarcoma cell line, Saos-2, was obtained from ATCC (AmericanType Culture Collection, Cat#HTB-85, Manassas, Va.) and were maintainedin DMEM containing 10% fetal bovine serum, 1% penicillin/streptomycin,and 2 mM glutamine. Saos-2 cells were transfected with either BCRP#4 toover express functional BCRP or BCRP#10 to over express non-functionalBCRP transporter. The cells were plated in 96-well plates at a densityof 1000 cells per each well in a 0.1 ml of medium and allowed to attachovernight. The next morning the medium was gently aspirated and serialdilutions of the compounds to be tested were added. The cells wereincubated at 37° C. in a 5% CO₂ incubator. After 6 days of exposure tothe test drugs, 10 μl of Alamar blue was added aseptically to each welland the plates were returned to the incubator for 6 hr. The amount ofthe fluorescent dye produced was measured on a Cytofluor®2300(Millipore, Bedford, Mass.) using an excitation wavelength of 530 nmand emission wavelength of 590 nm. The relative fluorescence unitsobtained were used to calculate the percentage growth at eachconcentration in relation to the untreated control values. From thepercentage growth values the IC₅₀ (inhibitory concentration required toinhibit the cell growth by 50% compared to control cells growth) valueswere derived. The resulting IC₅₀ values are presented in Table 9. TABLE9 IC₅₀ values for 5(S)-(2′-hydroxyethoxy)-20(S)-camptothecin,5(R)-(2′-hydroxyethoxy)-20(S)-camptothecin and 5(RS)-(2′-hydroxyethoxy)-20(S)-camptothecin against BCRP mutant and Breast cancerresistance protein (BCRP) over expressing Saos-2 cells. IC₅₀ (nM) DrugBCRP mut#10 BCRP#4 5(RS)-(2′- 387 1256 hydroxyethoxy)-20(S)-camptothecin 5(S)-(2′- 213 788 hydroxyethoxy)- 20(S)-camptothecin5(R)-(2′- 1299 >2000 hydroxyethoxy)- 20(S)-camptothecin

As shown in Table 9, 5(S)-(2′-hydroxyethoxy)-20(S)-camptothecin issuperior to 5(R)-(2′-hydroxyethoxy)-20(S)-camptothecin and5(RS)-(2′-hydroxyethoxy)-20(S)-camptothecin in terms of its cytotoxicactivity on BCRP mutant as well as BCRP over expressing Saos-2 cells.These results indicate that the rank order of cytotoxicity on both BCRPmut#10 and BCRP#4 was5(S)-(2′-hydroxyethoxy)-20(S)-camptothecin>5(RS)-(2′-hydroxyethoxy)-20(S)-camptothecin>5(R)-(2′-hydroxyethoxy)-20(S)-camptothecin.5(S)-(2′-hydroxyethoxy)-20(S)-camptothecin was ˜6 and >2.5 fold morecytotoxic than 5(R)-(2′-hydroxyethoxy)-20(S)-camptothecin on BCRP mut#10and BCRP#4 over expressing Saos-2 cells, respectively.

All references cited in this specification, including without limitationall papers, publications, patents, patent applications, presentations,texts, reports, manuscripts, brochures, books, internet postings,journal articles, periodicals, and the like, are hereby incorporated byreference into this specification in their entireties. The discussion ofthe references herein is intended merely to summarize the assertionsmade by their authors and no admission is made that any referenceconstitutes prior art. Applicants reserve the right to challenge theaccuracy and pertinency of the cited references.

In view of the above, it will be seen that the several advantages of theinvention are achieved and other advantageous results obtained.

As various changes could be made in the above methods and compositionsby those of ordinary skill in the art without departing from the scopeof the invention, it is intended that all matter contained in the abovedescription and shown in the accompanying drawings shall be interpretedas illustrative and not in a limiting sense. In addition it should beunderstood that aspects of the various embodiments may be interchangedboth in whole or in part.

1. 5(S)-(2′-hydroxyethoxy)-20(S)-camptothecin which is substantiallyfree of 5(R)-(2′-hydroxyethoxy)-20(S)-camptothecin.
 2. The5(S)-(2′-hydroxyethoxy)-20(S)-camptothecin according to claim 1, whichis substantially optically pure.
 3. The5(S)-(2′-hydroxyethoxy)-20(S)-camptothecin according to claim 1, whichhas a chemical purity of over 98%.
 4. The5(S)-(2′-hydroxyethoxy)-20(S)-camptothecin according to claim 1, wherein5(R)-(2′-hydroxyethoxy)-20(S)-camptothecin is present in an amount ofless than about 1.5% w/w.
 5. The5(S)-(2′-hydroxyethoxy)-20(S)-camptothecin according to claim 1, wherein5(R)-(2′-hydroxyethoxy)-20(S)-camptothecin is present in an amount ofless than about 1% w/w.
 6. The5(S)-(2′-hydroxyethoxy)-20(S)-camptothecin according to claim 1, wherein5(R)-(2′-hydroxyethoxy)-20(S)-camptothecin is present in an amount ofless than about 0.5% w/w.
 7. The5(S)-(2′-hydroxyethoxy)-20(S)-camptothecin according to claim 1, wherein5(R)-(2′-hydroxyethoxy)-20(S)-camptothecin is present in an amount ofless than about 0.1% w/w.
 8. The5(S)-(2′-hydroxyethoxy)-20(S)-camptothecin according to claim 1, whereinthe camptothecin dimer impurity having the chemical structure of formulaV is present in the 5(S)-(2′-hydroxyethoxy)-20(S)-camptothecin in anamount of less than about 1.5% w/w.
 9. The5(S)-(2′-hydroxyethoxy)-20(S)-camptothecin according to claim 1, whereinthe camptothecin dimer impurity having the chemical structure of formulaV is present in the 5(S)-(2′-hydroxyethoxy)-20(S)-camptothecin in anamount of less than about 1% w/w.
 10. The5(S)-(2′-hydroxyethoxy)-20(S)-camptothecin according to claim 1, whereinthe camptothecin dimer impurity having the chemical structure of formulaV is present in the 5(S)-(2′-hydroxyethoxy)-20(S)-camptothecin in anamount of less than about 0.1% w/w.
 11. A method of inhibiting theactivity of topoisomerase I in a cell, the method comprisingadministering to the cell a topoisomerase I inhibiting effective amountof 5(S)-(2′-hydroxyethoxy)-20(S)-camptothecin which is substantiallyfree of 5(R)-(2′-hydroxyethoxy)-20(S)-camptothecin.
 12. The methodaccording to claim 11, wherein the5(S)-(2′-hydroxyethoxy)-20(S)-camptothecin is administered to the cellin vitro.
 13. The method according to claim 11, wherein the5(S)-(2′-hydroxyethoxy)-20(S)-camptothecin is administered to the cellin vivo.
 14. A pharmaceutical composition comprising the5(S)-(2′-hydroxyethoxy)-20(S)-camptothecin as described in claim 1 and apharmaceutically acceptable carrier.
 15. The pharmaceutical compositionaccording to claim 14, in a form wherein a single dose of thecomposition for an adult human comprises from about 5 mg to about 25 mgof 5(S)-(2′-hydroxyethoxy)-20(S)-camptothecin.
 16. A method of using5(S)-(2′-hydroxyethoxy)-20(S)-camptothecin for the production of apharmaceutical composition, the method comprising intermixing the5(S)-(2′-hydroxyethoxy)-20(S)-camptothecin described in claim 1 with apharmaceutically acceptable carrier.
 17. A method of making the5(S)-(2′-hydroxyethoxy)-20(S)-camptothecin described in claim 1, themethod comprising the steps: a) intermixing5(RS)-(2′-hydroxyethoxy)-20(S)-camptothecin with a solvent selected fromn-butanol or tetrahydrofuran; b) refluxing the mixture for a period offrom about 1 to about 4 hours; c) cooling the mixture to a temperatureof from about 40° C. to about 50° C.; and d) separating solid5(S)-(2′-hydroxyethoxy)-20(S)-camptothecin from the mixture.
 18. Themethod according to claim 17, further comprising the steps: e) washingthe solid 5(S)-(2′-hydroxyethoxy)-20(S)-camptothecin with a solventselected from n-butanol or tetrahydrofuran; and d) drying the solid5(S)-(2′-hydroxyethoxy)-20(S)-camptothecin to yield5(S)-(2′-hydroxyethoxy)-20(S)-camptothecin that is substantially free of5(R)-(2′-hydroxyethoxy)-20(S)-camptothecin.
 19. A method of using5(S)-(2′-hydroxyethoxy)-20(S)-camptothecin to treat cancer in a subject,the method comprising administering to the subject an effective amountof the 5(S)-(2′-hydroxyethoxy)-20(S)-camptothecin described in claim 1.20. The method according to claim 19, wherein the subject is a mammal.21. The method according to claim 19, wherein the subject is a human.22. The method according to claim 19, wherein the5(S)-(2′-hydroxyethoxy)-20(S)-camptothecin is administered to thesubject orally.
 23. The method according to claim 19, wherein the canceris one that is selected from the group consisting of ovarian cancer,osteosarcoma, leukemia, lymphoma, small cell lung cancer, non-small celllung cancer, central nervous system (CNS) cancer, breast cancer,colorectal cancer, renal cancer, bladder cancer, breast cancer,epidermoid cancer, lung cancer, melanoma, prostate cancer, uterinecancer, soft tissue sarcoma, pancreatic cancer and rhabdomyosarcoma. 24.The method according to claim 23, wherein the cancer is one that isselected from the group consisting of colon cancer, ovarian cancer andosteosarcoma.
 25. The method according to claim 23, wherein the canceris one that is selected from the group consisting of osteosarcoma,colorectal cancer and pancreatic cancer.
 26. The method according toclaim 23, wherein the cancer is one that is selected from the groupconsisting of bladder, breast, CNS, colon, epidermoid, lung, ovarian,melanoma, prostate, renal and uterine cancers.
 27. The method accordingto claim 19, wherein the 5(S)-(2′-hydroxyethoxy)-20(S)-camptothecin isadministered to the subject in an amount of from about 0.1 to about 10mg/kg/day.
 28. The method according to claim 19, wherein the5(S)-(2′-hydroxyethoxy)-20(S)-camptothecin is administered to thesubject in an amount of from about 0.1 to about 5 mg/kg/day.
 29. Themethod according to claim 19, wherein the subject is one that is in needof treatment for cancer.